Skilled nursing facilities fall below standards

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Many skilled nursing facilities (SNF) are failing to develop care plans that meet requirements or are not providing services in accordance with care plans, according to a new report.

The report, produced by the Department of Health and Human Services Office of the Inspector General, was based on a medical record review of a stratified simple random sample of SNF stays from 2009.

The reviewers determined the extent to which SNFs developed care plans that met Medicare requirements, provided services in accordance with care plans, and planned for beneficiaries' discharges as required. Reviewers also identified examples of poor quality care.

“For 37 per cent of stays, SNFs did not develop care plans that met requirements or did not provide services in accordance with care plans,” stated the report. “For 31 per cent of stays, SNFs did not meet discharge planning requirements. Medicare paid approximately $5.1 billion for stays in which SNFs did not meet these quality-of-care requirements.

“Additionally, reviewers found examples of poor quality care related to wound care, medication management, and therapy. These findings raise concerns about what Medicare is paying for. They also demonstrate that SNF oversight needs to be strengthened to ensure that SNFs perform appropriate care planning and discharge planning.”

The report recommends that the Centers for Medicare and Medicaid Services strengthen the regulations on care planning and discharge planning, provide guidance to SNFs to improve care planning and discharge planning, increase surveyor efforts to identify SNFs that do not meet care planning and discharge planning requirements and to hold these SNFs accountable, link payments to meeting quality-of-care requirements, and follow up on the SNFs that failed to meet care planning and discharge planning requirements or that provided poor quality care. CMS concurred with all five of these recommendations.